Overview of microbes in hypertension

High blood pressure (BP), known as hypertension, is a major contributing factor to the development of cardiovascular disease. The development and pathogenesis of hypertension involve a wide array of factors including genetics, environment, hormones, hemodynamics, and inflammation. There is a significantly positive association between higher levels of colonization by Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola (etiologic bacterial burden) below the gum line, and the presence of hypertension. The use of antibiotics during pregnancy, which is likely indicative of bacterial infections severe enough to require antibiotic treatment, is associated with a slight increase in average arterial BP. Cytomegalovirus infection is a risk factor for heightened arterial BP and acts as a co-factor in the development of aortic atherosclerosis. The relationship between hypertension and coronavirus disease 2019 involves endothelial dysfunction and dysregulation of the renin-angiotensin system. The effects of gut microbiota on BP, whether beneficial or harmful, are influenced by multiple factors including genetics, epigenetics, lifestyle choices, and antibiotic usage. These variables collectively contribute to overall BP levels and the control of hypertension. Several reports have examined the BP levels of patients infected with the Zika virus. In regions with a high incidence of nasopharyngeal carcinoma, hypertension has been linked to a higher risk of Epstein-Barr virus reactivation. Also, a potential causal link has been found between malaria and elevated BP. Also, the elevated prevalence of hypertension among dengue patients during their initial visit suggests that relying solely on BP measurements to predict severe infection may not be clinically reliable.

Role of major adipokines in hypertension: A literature review

The incidence and prevalence of hypertension are increasing as a consequence of the obesity epidemic. Adipocytes and their variety of factors make contributions to the long-term regulation of blood pressure. The pathophysiologic states of hypertension, including obesity, are regulated by the production of adipocyte-derived factors. Increased body mass index was closely linked to elevated blood pressure. Mostly the hypertensive subjects were obese as well as overweight. There are numerous adipokines, however, this review article only focuses on the major adipokines including chemerin, visfatin, retinol-binding protein 4, plasminogen activator inhibitor-1, monocyte chemotactic protein-1, omentin-1, lipocalin-2, vaspin, progranulin, complement c1q tumor necrosis factor-related protein, and nesfatin-1 role in the pathogenesis of hypertension. This review article concludes the significant association of major adipokines in the pathogenesis of hypertensives. New research should be focused on other newly reported adipokine roles in hypertensive subjects and the management of these adipokines in hypertensive subjects. The discovery of this information could result in the creation of antihypertensive medications, particularly those that focus on obesity-related hypertension.

Cardiac markers: Role in the pathogenesis of arterial hypertension

Cardiac biomarkers may play unique roles in the prognostic evaluation of patients with hypertension, as many cardiac biomarker levels become abnormal long before the onset of obvious cardiovascular disease (CVD). There are numerous cardiac markers. However, this review article only reported the roles of creatinine kinase-MB, cardiac troponins, lipoprotein a, osteopontin, cardiac extracellular matrix, C-reactive protein, cardiac matrix metalloproteinases, cardiac natriuretic peptides, myoglobin, renin, and dynorphin in the pathogenesis of hypertension. This article explained recent major advances, as well as discoveries, significant gaps, and current debates and outlined possible directions for future research. Further studies are required to determine the association between myoglobin and other cardiac markers in hypertension. Moreover, therapeutic approaches are required to determine the early control of these cardiac markers, which ultimately reduce the prevalence of CVDs.

Self-efficacy for managing hypertension and comorbid conditions

BACKGROUND

Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal. For individuals with hypertension and other chronic conditions, self-efficacy has been an essential factor to predict adherence to treatment behaviors.

AIM

To examine self-efficacy for managing chronic conditions in individuals with hypertension.

METHODS

A total of 1087 individuals with chronic conditions in two groups (hypertension and non-hypertension groups) were selected in this study. The two groups’ self-efficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system self-efficacy for managing chronic conditions measures (PROMIS-SE); daily activities, emotions, medication and treatment, social interactions, and symptoms. Also, the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.

RESULTS

Among 1087 participants, 437 reported having hypertension. The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities [F (1, 598) = 5.63, P < 0.05]. Structural equation modeling indicated that for individuals with hypertension, two domains of PROMIS-SE (managing daily activities and emotions) significantly predict global physical health (P < 0.001 and P < 0.01 sequentially), and one domain (managing emotions) significantly predicts mental health (P < 0.001). Hypertension patients’ general quality of life was significantly predicted by global physical health (P < 0.001) and mental health (P < 0.001).

CONCLUSION

The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group. In this hypertension group, self-efficacy functioned as an indirect predictor of general quality of life, mediated by global physical and mental health.

Loss of cavin1 and expression of p-caveolin-1 in pulmonary hypertension: Possible role in neointima formation

BACKGROUND

Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality rate; and neointima formation leads to the irreversibility of the disease. We have previously reported that in rats, monocrotaline (MCT) injection leads to progressive disruption of endothelial cells (EC), and endothelial caveolin-1 (cav-1) loss, accompanied by the activation of pro-proliferative pathways leading to PH. Four weeks post-MCT, extensive endothelial cav-1 loss is associated with increased cav-1 expression in smooth muscle cells (SMC). Exposing the MCT-treated rats to hypoxia hastens the disease process; and at 4 wk, neointimal lesions and occlusion of the small arteries are observed.

AIM

To identify the alterations that occur during the progression of PH that lead to neointima formation.

METHODS

Male Sprague-Dawley rats (150-175 g) were divided in 4 groups (n = 6-8 per group): controls (C); MCT (M, a single sc injection 40 mg/kg); Hypoxia (H, hypobaric hypoxia); MCT + hypoxia (M+H, MCT-injected rats subjected to hypobaric hypoxia starting on day1). Four weeks later, right ventricular systolic pressure (RVSP), right ventricular hypertrophy (RVH), lung histology, and cav-1 localization using immunofluorescence technique were analyzed. In addition, the expression of cav-1, tyrosine 14 phosphorylated cav-1 (p-cav-1), caveolin-2 (cav-2), cavin-1, vascular endothelial cadherin (VE-Cad) and p-ERK1/2 in the lungs were examined, and the results were compared with the controls.

RESULTS

Significant PH and right ventricular hypertrophy were present in M and H groups [RVSP, mmHg, M 54±5*, H 45±2*, vs C 20±1, P < 0.05; RVH, RV/LV ratio M 0.57±0.02*, H 0.50±0.03*, vs C 0.23±0.007, P < 0.05]; with a further increase in M+H group [RVSP 69±9 mmHg, RV/LV 0.59±0.01 P < 0.05 vs M and H]. All experimental groups revealed medial hypertrophy; but only M+H group exhibited small occluded arteries and neointimal lesions. Immunofluorescence studies revealed endothelial cav-1 loss and increased cav-1 expression in SMC in M group; however, the total cav-1 level in the lungs remained low. In the M+H group, significant endothelial cav-1 loss was associated with increasing expression of cav-1 in SMC; resulting in near normalization of cav-1 levels in the lungs [cav-1, expressed as % control, C 100±0, M 22±4*, H 96±7, M+H 77±6, * = P < 0.05 vs C]. The expression of p-cav-1 was observed in M and M+H groups [M 314±4%, M+H 255±22% P < 0.05 vs C]. Significant loss of cav-2 [% control, C 100±0, M 15±1.4*, H 97±7, M+H 15±2*; M and M+H vs C, * = P < 0.05], cavin-1 [% control, C 100±0, M 20±3*, H 117±7, M+H 20±4*; M and M+H vs C, P < 0.05] and VE-Cad [% control, C 100±0, M 17±4*, H 96±9, M+H 8±3*; M and M+H vs C, P < 0.05] was present in M and M+H groups, confirming extensive disruption of EC. Hypoxia alone did not alter the expression of cav-1 or cav-1 related proteins. Expression of p-ERK1/2 was increased in all 3 PH groups [%control, C 100±0, M 284±23*, H 254±25*, M+H 270±17*; * = P < 0.05 vs C].

CONCLUSION

Both cavin-1 loss and p-cav-1 expression are known to facilitate cell migration; thus, these alterations may in part play a role in neointima formation in PH.

Achieving control of resistant hypertension: Not just the number of blood pressure medications

Resistant hypertension (RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy (BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.

Blood pressure goals: A moving target

Clinical guidelines on hypertension have evolved over the past several decades. Each recommends varying blood pressure (BP) cut-offs which define hypertension, determine the thresholds to initiate pharmacotherapy, and guide treatment targets. In addition, different techniques of measuring BP in clinical trials may further contribute to the discrepancies in the achieved BP targets. Physicians find it difficult to navigate through different recommendations for hypertension management based on studies among different age groups and patients with a variety of co-morbidities and target organ involvement. In 2003, JNC 7 recommended a BP goal of < 140/90 mmHg in the general population and < 130/80 mmHg in those with diabetes mellitus or renal disease. JNC 8 re-set the BP target at < 140/90 mmHg for all adults under the age of 60 regardless of co-morbidities, and an even higher target of < 150/90 mmHg for those 60 years or older without diabetes or chronic kidney disease. The more recent results of the Systolic BP Intervention Trial (SPRINT) have a significant influence on the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline which redefines hypertension as BP ≥ 130/80 mmHg. It emphasizes individualized cardiovascular risk assessment and recommends a more aggressive BP target of < 130/80 mmHg and a treatment threshold based on the age, co-morbidities, and cardiovascular risk. The 2017 ACC/AHA guideline also advocates proper BP measurement and provides the estimates of corresponding BP values for clinic, home, and ambulatory BP monitoring measurements. A higher prevalence of hypertension is expected based on the ACC/AHA 2017 guideline. Its implementation may potentially lead to better BP control through enhanced awareness, improved adherence, and more timely initiation and intensification of pharmacologic therapy. Although there is no one-size-fits-all BP target, the ACC/AHA 2017 guideline is simple, inclusive and practical. Nonetheless, more studies are warranted to help further individualize BP goals for elderly patients and those with certain co-morbidities or multiple cardiovascular risk factors.

Association between G-protein β3 subunit gene and isolated systolic blood pressure elevation of greater than 130 mmHg: A large-scale cross-sectional study in the Japanese population

AIM

To investigate whether GNB3 C825T single nucleotide polymorphism (SNP) contributes to systolic blood pressure (SBP) ≥ 130 mmHg in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure (DBP) < 85 mmHg.

METHODS

We analyzed 11008 Japanese subjects, including 2797 cases (SBP ≥ 130 and DBP < 85 mmHg) who were not taking anti-hypertensive medication and 8211 controls (SBP < 130 and DBP < 85 mmHg), all of whom enrolled in the genome banking project of the 21^st Century COE (Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender (male and female) and age (≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqMan probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios (ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index.

RESULTS

Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.

CONCLUSION

This study indicates that the TT genotype of the GNB3 C825T SNP may contribute to SBP elevation of greater than 130 mmHg compared to the CC genotype in Japanese males aged ≤ 49 years.

Hypertension, type IV cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach

Hypertension represent one of the most important comorbid factors in chronic kidney disease (CKD) patients and its prevalence increases from 65% to 95% according to glomerular filtration rate decline. CKD patients need to maintain their blood pressure levels into 130/80 mmHg according to most recent guidelines. Despite of many therapeutic agents, achievement of ideal blood pressure levels remains so far from the ideal ones. Hypertensive disease represent most important risk factor to develop a type IV cardiorenal syndrome, while prevalence of end stage renal disease is still raising and it represents worldwide epidemiological challenge. Correct management of hypertensive disease can obtain better control on CKD progression.

Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies

In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges and opportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries (141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80s and the first decade of the 20^th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.

Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target?

Reduction of diastolic blood pressure to less than 60-80 mmHg does not improve mortality and may lead to adverse cardiovascular events in high risk patient populations. Despite a growing body of evidence supporting the J-curve phenomenon, no major society guidelines on hypertension include a lower threshold target for diastolic blood pressure. Many major society guidelines for hypertension have been updated in the last 5 years. Some guidelines include goals specific to age and co-morbid conditions. The Sixth Joint Task Force of the European Society of Cardiology and the Canadian Hypertension Education Program are the only guidelines to date that have recommended a lower threshold target, with the Canadian guidelines recommending a caution against diastolic blood pressure less than or equal to 60 mmHg in patients with coronary artery disease. While systolic blood pressure has been proven to be the overriding risk factor in hypertensive patients over the age of 50 years, diastolic blood pressure is an important predictor of mortality in younger adults. Post hoc data analysis of previous clinical trials regarding safe lower diastolic blood pressure threshold remains inconsistent. Randomized clinical trials designed to determine the appropriate diastolic blood pressure targets among different age groups and populations with different comorbidities are warranted. Hypertension guideline goals should be based on an individual’s age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.

Role of adipocytes in hypertension

Although it has known for some time that obesity is associated with salt sensitivity and hypertension, recent data suggests that the adipocyte may actually be the proximate cause of this physiological changes. In the following review, the data demonstrating this association as well as the potentially operative pathophysiological mechanisms are reviewed and discussed.

RhoA signaling and blood pressure: The consequence of failing to “Tone it Down”

Uncontrolled high blood pressure is a major risk factor for heart attack, stroke, and kidney failure and contributes to an estimated 25% of deaths worldwide. Despite numerous treatment options, estimates project that reasonable blood pressure (BP) control is achieved in only about half of hypertensive patients. Improvements in the detection and management of hypertension will undoubtedly be accomplished through a better understanding of the complex etiology of this disease and a more comprehensive inventory of the genes and genetic variants that influence BP regulation. Recent studies (primarily in pre-clinical models) indicate that the small GTPase RhoA and its downstream target, Rho kinase, play an important role in regulating BP homeostasis. Herein, we summarize the underlying mechanisms and highlight signaling pathways and regulators that impart tight spatial-temporal control of RhoA activity. We also discuss known allelic variations in the RhoA pathway and consider how these polymorphisms may affect genetic risk for hypertension and its clinical manifestations. Finally, we summarize the current (albeit limited) clinical data on the efficacy of targeting the RhoA pathway in hypertensive patients.

Management of hypertension: Current state of the art and challenges

Hypertension is a major modifiable cardiovascular risk factor. Hypertension is also recognized as the most important risk factor for global disease burden. It is well established that a sustained reduction in blood pressure by drugs reduces the incidence of cardiovascular morbidity and mortality. In recent years, studies and new guidelines published for the management of hypertension. Awareness, treatment and control of hypertension are very poor, despite the new guidelines. We highlighted the management of hypertension in the light of current literature.

Roles of catecholamine related polymorphisms in hypertension

The objective of this review is to summarize current data obtained so far in catecholamine-essential hypertension (EH) relationships on a genetic basis. As the major elements driving the sympathetic system’s actions, catecholamines modulate a variety of physiological processes and mutations related to the system. This could generate serious disorders, such as severe mental illnesses, stress-induced disorders, or impaired control of blood pressure or motor pathways. EH is idiopathic, and the genetic basis of its causes and substantial interindividual discrepancies in response to different types of treatments are the focus of interest. Susceptibility to disease or efficacy of treatments are thought to reflect genomic variabilities among individuals. Therefore, outlining the available knowledge in functional genetic polymorphisms linked to EH will make the picture clearer and will help to establish future prospects in the field.

Renal venous hypertension

Renal venous hypertension usually seen in young, otherwise healthy individuals and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, computed tomography, or magnetic resonance conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method. This review of the literature discusses normal and pathological developmental aspects of renocaval venous segment and related circulatory disorders, summarizes congenital and acquired changes in left renal vein and their impact on development of renal venous hypertension. Also will be discussed surgical tactics of portosystemic shunting and their potential effects on renal hemodynamics.

Place of baroreceptor activation therapy in the treatment of resistant hypertension

This mini review describes the development of the therapeutic concept of baroreceptor stimulation over the last fifty years alongside the more recent introduction of it for the treatment of drug - resistant hypertension. The pros and cons of this strategy of treatment over renal sympathetic denervation are also discussed in the light of the results of the studies done in the last decade.

Regression of cardiovascular remodeling in hypertension: Novel relevant mechanisms

Asymptomatic organ damage due to progressive kidney damage, cardiac hypertrophy and remodeling put hypertensive patients at high risk for developing heart and renal failure, myocardial infarction and stroke. Current antihypertensive treatment normalizes high blood pressure, partially reverses organ damage, and reduces the incidence of heart and renal failure. Activation of the renin-angiotensin system (RAS) is a primary mechanism of progressive organ damage and, specifically, a major cause of both renal and cardiovascular fibrosis. Currently, inhibition of the RAS system [mainly with angiotensin I converting enzyme inhibitors or angiotensin II (Ang II) receptor antagonists] is the most effective antihypertensive strategy for normalizing blood pressure and preventing target organ damage. However, residual organ damage and consequently high risk for cardiovascular events and renal failure still persist. Accordingly, in hypertension, it is relevant to develop new therapeutic perspectives, beyond reducing blood pressure to further prevent/reduce target organ damage by acting on pathways that trigger and maintain cardiovascular and renal remodeling. We review here relevant novel mechanisms of target organ damage in hypertension, their role and evidence in prevention/regression of cardiovascular remodeling and their possible clinical impact as well. Specifically, we focus on the signaling pathway RhoA/Rho kinase, on the impact of the vasodilatory peptides from the RAS and some insights on the role of estrogens and myocardial chymase in cardiovascular hypertensive remodeling.

Dashing away hypertension: Evaluating the efficacy of the dietary approaches to stop hypertension diet in controlling high blood pressure

The dietary approaches to stop hypertension (DASH) diet has been developed and popularized as a non-pharmaceutical intervention for high blood pressure reduction since 1995. However, to date, a comprehensive description of the biochemical rationale behind the diet’s principal guidelines has yet to be compiled. With rising interest for healthy and reliable life-style modifications to combat cardiovascular disease, this review aims to compile the most recent and relevant studies on this topic and make an informed assessment as to the efficacy of and underlying mechanisms operant in the DASH diet. Specifically, the merits of lowering dietary intake of sodium and saturated fat, as well as increasing the intake of fruits, vegetables, fiber, and dairy, have been shown to attenuate hypertension individually. Upon review of this evidence, we conclude that the combination of dietary patterns proposed in the DASH diet is effective in attenuating high blood pressure. We also suggest that efforts to more widely implement adoption of the DASH diet would be beneficial to public health.

Kidney and cardiovascular risk in primary hypertension

In patients with primary hypertension, therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone. Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in defining individual risk. Given the high prevalence of hypertension in the population at large, however, extensive diagnostic evaluation is often impractical or unfeasible in clinical practice. Low cost, easy to use markers of risk are needed to improve the clinical management of patients with hypertension. Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful, low cost tools to optimize cardiovascular risk assessment. A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.

Estimated net endogenous acid production and risk of prevalent and incident hypertension in community-dwelling older people

AIM: To investigate the associations of dietary acid-base load with prevalent and incident hypertension in community-living Chinese older adults in Hong Kong.

METHODS: Participants aged ≥ 65 years participating in a cohort study examining the risk factors for osteoporosis completed a validated food frequency questionnaire (FFQ) at baseline between 2001 and 2003. Estimated net endogenous acid production (NEAP) was calculated using Frassetto’s method based on the diet’s protein to potassium ratio derived from the FFQ. Prevalent and 4-year incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or self-reported use of anti-hypertensive medications. Multivariable logistic regression was used for cross-sectional analysis (n = 3956) to assess the association between estimated NEAP and prevalent hypertension, and for longitudinal analysis (n = 795) on its association with 4-year incident hypertension, with adjustment for various potential socio-demographic and lifestyle factors.

RESULTS: Median estimated NEAP of the participants was 47.7 (interquartile range: 36.2, 60.9) g/mEq. Participants in the highest quartile of energy-adjusted estimated NEAP was associated with increased likelihood of prevalent hypertension than those in the lowest quartile of energy-adjusted estimated NEAP [multivariable OR = 1.66 (95%CI: 1.22 to 2.26, P_trend = 0.002)]. No significant association was observed between energy-adjusted estimated NEAP and risk of incident hypertension.

CONCLUSION: A high dietary acid load was independently associated with an increased likelihood of prevalent hypertension in ambulant older Chinese people in Hong Kong. The longitudinal analyses failed to show any causal relationship between dietary acid load and hypertension in this population.

Multi-slice computerized tomography critical role in transcatheter aortic valve implantation plan: Review of current literature

Transcatheter aortic valve implantation (TAVI) has been shown in improve outcome of severe aortic stenosis (AS) patients, deemed surgical high-risk or inoperable, and has grown popular in the past decade. The procedure requires accurate prior planning, and demands an integration of a “Heart Team” consisted from cardiac surgeons, interventional cardiologists, and imaging experts. The role of cardiac imaging and especially multi-slice computerized tomography (MSCT) has been a mainstay of pre-evaluation of severe AS patients that allows to accurately depict and size the cardiac and vascular structures, and has become the primary tool for procedural planning. This article is aimed to evaluate current uses of MSCT in severe AS patients undergoing TAVI, delineate the various measurements derived from this modality and review current literature regarding it’s advantages over other techniques.

Dairy: A lower percent investment in the volatile hypertensive environment

In cross-sectional and intervention studies, low-fat dairy has proven to be effective in lowering blood pressure in a hypertensive population. Contributing mechanisms include the angiotensin-converting enzyme-inhibiting effects of peptides and possible interplay between calcium and vitamin D. Easily added to the diet, low-fat dairy is an attractive addition to nutritional, lifestyle, and pharmacological interventions to treat hypertension.

Novel contributions of multimodality imaging in hypertension: A narrative review

Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.

Symplicity-3 hypertension trial: Basic and clinical insights

Symplicity-3 hypertension (HTN) was a recently completed clinical trial that was assumed to be the basis for the approved use of renal artery denervation for the treatment of resistant hypertension in the United States. Dramatic reductions in blood pressure had been reported in two clinical trials (Symplicity-1HTN, -2HTN) carried out in Europe, however Symplicity-3HTN did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 mo after renal artery denervation as compared with a sham control. (Denervation group, blood pressure reduction: -14 ± 24, Sham control: -12 ± 26 mmHg). In this review we discuss several potential explanations for the failure of efficacy of Symplicity-3HTN taking into account basic and clinical factors which could have played a role in the discrepancy between the European and American experience.